急性有机磷农药中毒两组药物救治的效果观察  

Comparison of two therapies in treating acute organophosphorus pesticide poisoning

作　　者：艾莉[1] 

机构地区：[1]山东省菏泽市立医院急救中心,山东菏泽274031

出　　处：《中国中西医结合急救杂志》2015年第4期408-411,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：山东省菏泽市科技发展计划项目（201222）

摘　　要：目的探讨大黄联合蒙脱石（思密达）治疗急性有机磷农药中毒（AOPP）的临床疗效。方法选择2011年6月至2014年6月山东省菏泽市立医院急救中心收治的重度AOPP患者76例，将患者按随机数字表法分为观察组和对照组，每组38例。两组均给予彻底洗胃、适量应用阿托品及盐酸戊乙奎醚（长托宁）解毒、氯磷定复能剂等综合常规治疗；观察组在常规治疗基础上应用大黄粉30g导泻、思密达30g吸附4h1次，两药交替应用，连用48h；对照组在常规治疗基础上应用33％硫酸镁60mL导泻、漂白土200g吸附4h1次，两药交替应用，连用48h。观察两组治疗效果、用药剂量、并发症发生率及病死率。结果观察组首次排便时间（h：5．8±3．7比9．4±4．6）、胃肠功能恢复时间（h：21．7±6．1比25．2±8．3）、阿托品化时间（min：51．8±23．9比68．5±20．1）、意识恢复时间（d：2．3±1．2比3．6±1．9）、胆碱酯酶（ChE）活力恢复50％以上时间（d：4．7±2．3比6．1±2．9）和住院时间（d：9．2±4．9比12．3±6．9）均较对照组明显缩短（P〈0．05或P〈0．01）；阿托品用量（mg：234．3±37．1比265．7±31．4）、长托宁用量（mg：19．2±14．3比36．7±25．4）和中毒反跳[7．9％（3／38）比31．6％（12／38）]、中间综合征（2．6％（1／38）比18．4％（7／38）]、迟发性神经病[0（0／38）比15．8％（6／38）]等不良反应发生率均较对照组明显降低（P〈0．05或P〈0．01）；两组均无死亡病例。结论思密达联合大黄是目前彻底清除AOPP患者胃肠道残留毒物较好的导泻和吸附联合用药方法，能减少患者药物用量和并发症，并缩短住院时间。Objective To investigate the clinical effect of rhubarb combined with smccta in the treatment of acute organophosphorus pesticide poisoning （AOPP）. Methods Seventy-six patients with severe AOPP admitted in the Emergency Centre of Heze Municiple Hospital in Shandong Province from June 2011 to June 2014 were enrolled in this study. They were divided into observation group and control group by the random number table method, 38 cases in each group. The comprehensive routine treatment of gastric lavage to thoroughly clear the gastric content, appropriate application of penehyclidine and atropine for detoxication, pralidoxime chloride, etc. were given to the two groups. On the basis of the above conventional treatment, the observation group was treated with rhubarb 30 g for catharsis and smecta 30 g for adsorption once in every 4 hours, two drugs applied alternately for 48 hours, while the control group was treated with 33% magnesium sulfate 60 mL for catharsis and bleaching clay 200 g for adsorption once in every 4 hours, two drugs applied alternately for 48 hours. The treatment effect, dosage, incidence of complication and case fatality rate in both groups were observed. Results The first defecation time （hours： 5.8 ± 3.7 vs. 9.4 ± 4.6）, gastrointestinal function recovery time （hours： 21.7 ± 6.1 vs. 25.2 ± 8.3）, atropinization time （minutes： 51.8 ± 23.9 vs. 68.5 ± 20.1）, conscious recovery time （days： 2.3 ± 1.2 vs. 3.6 ± 1.9）, the time of cholinesterase （ChE） activity returning to more than 50% （days： 4.7 ± 2.3 vs. 6.1 ± 2.9） and the length of stay in hospital （days： 9.2± 4.9 vs. 12.3 ± 6.9） were obviously shorter in the observation group than those of the control group （P 〈 0.05 or P 〈 0.01）; the used dosage of atropine （rag： 234.3 ± 37.1 vs. 265.7 ± 31.4） and penehyclidine （mg： 19.2 ± 14.3 vs. 36.7 ± 25.4） and the incidence of adverse reactions of poisoning rebound [7.9% （3/38） vs. 31.6% （12/38）], intermediate syndrome [2.6% �

关 键 词：有机磷农药中毒 大黄 思密达 硫酸镁 漂白土 

分 类 号：R595.4[医药卫生—内科学]